A 62-year-old male patient was admitted to our hospital with the chief complaint of motor aphagia that developed 2 hours previous to his visit. He had a history of traumatic subdural hemorrhage, which occurred 3 years ago, but had no neurological sequelae. There was no history of fever, syncope, orthopnea, or weight loss. His physical examination

was unremarkable and electrocardiography showed a normal sinus rhythm. His chest X-ray revealed no abnormal findings. Routine laboratory tests showed normal findings except for an elevated C-reactive Inhibitors,research,lifescience,medical protein (CRP) level of 0.92 mg/dL and an elevated erythrocyte sedimentation rate (ESR) of 36 mm/hr. Upon the magnetic resonance imaging of the brain, there was evidence of an acute embolic infarction (Fig. 1). As part of the patient’s workup to find the source of the embolism, transthoracic echocardiography (TTE) was done. TTE revealed a highly mobile mass at the anterior mitral valve Brefeldin A manufacturer leaflet Inhibitors,research,lifescience,medical and trivial mitral regurgitation (Fig. 2A and B). The patient subsequently underwent transesophageal echocardiography, which also revealed a 1 cm sized mass (Fig. 2C and D). There was no thrombus in the left atrial appendage. A spherical mass was attached to the mitral valve Inhibitors,research,lifescience,medical by a short stalk and was located on

the left ventricular (LV) side of the mitral valve. The mass was heterogenous in appearance, which showed central echolucent area, and prolapse of the mass into the LV was observed Inhibitors,research,lifescience,medical during diastole. To exclude the diagnosis of infective endocarditis, 3 pairs of blood cultures were obtained from 3 separate sites which yielded no bacterial growth after five days. The patient did not have predisposing conditions of infective endocarditis, fever, any immunologic phenomena such as Osler’s node, Roth’ spot, or glumerulonephritis, and other microbiologic evidence of active infection. Therefore, our case did not fulfill the Duke criteria for the clinical diagnosis of infective endocarditis. An urgent surgical Inhibitors,research,lifescience,medical resection was planned to avoid the risk of further systemic embolization. Fig.

1 Brain magnetic resonance imaging. High signal intensity lesion on diffusion weighted imaging (A) with decreased signal intensity on apparent diffusion coefficient value at left precentral gyrus (B) was observed which indicates hyperacute infarction. Fig. 2 The transthoracic echocardiography (A and B) and transesophageal echocardiography (C and D) showed a 1 × 1 cm sized, highly mobile mass (arrows) on the anterior mitral valve Mephenoxalone leaflet. LV: left ventricle, LA: left atrium, RV: right ventricle, RA: … The patient underwent sternotomy and cardiopulmonary bypass. During the operation, an 1 × 1 cm sized pedunculated mass arising at the anterior mitral valve leaflet was found (Fig. 3). The mass was whitish, round, and soft, and it was attached to the mitral valve by a short narrow stalk. After complete excision of the mass, there was no sign of mitral regurgitation and replacement of the mitral valve was not done.